CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 4, May 2013
AFRICA
105
modern lifestyle, the spectrum of CVD among those in Africa
is still dominated by cardiomyopathies, pericardial diseases and
pulmonary hypertension. While improving the detection and
management of the latter is critical, it is also very important for
healthcare providers in Africa to remain watchful as the CVD
profile in people with HIV may change with time, as many
people will live longer on antiretroviral therapies.
Childhood CVDs are discussed by Drs Zühlke, Mirabel
and Marijon
12
in an article demonstrating that these conditions
are largely dominated by rheumatic heart diseases (RHD) and
congenital heart disease (CHD). They tend to occur at much
higher rates in Africa than in other parts of the world, where
they are associated with poor prognosis resulting from delayed
diagnosis and treatment. While appropriate prevention and/or
treatment measures for these conditions exist, their uptake in
Africa is still inappropriate. In spite of the resource constrains,
implementation projects for early diagnosis of CHD, followed by
corrective surgery are underway in many parts of the continent.
13
Such efforts for RHD are limited by the many uncertainties
regarding optimal age for screening, the appropriate screening
tool, and course of action following screening.
14
Cardiovascular diseases of a modern lifestyle and major risk
factors are covered in four articles in the series. In one of these
four, myocardial infarction and stroke in Africa are revisited by
Ntsekhe and Damasceno.
15
Their report suggests that ischaemic
heart disease is still a relatively modest contributor of CVD in
Africa; however, the burden of risk factors for atherosclerosis is
rapidly increasing across the diversity of rural and urban settings
in Africa.
Stroke on the other hand is now an established major cause of
premature mortality and disabilities in Africa, resulting primarily
from hypertension and less from atherosclerosis. Hypertension
is covered in great detail by Ogah and Rayner,
16
showing that
hypertension is one of the most investigated cardiovascular
risk factors in Africa. Since 2007 when the last comprehensive
overview of hypertension studies in Africa was published,
17
at
least 38 new studies have been reported, mostly from urban
Africa. Increasingly high prevalences of hypertension continue
to be reported against a background of low rates of detection,
treatment and control.
The last articles of the series are two companion articles
by Kengne and collaborators,
18,19
focusing on diabetes and
obesity. They report that diabetes incidences are on the rise
in Africa, essentially paralleling those for obesity, but studies
to characterise them have been less than optimal. The care of
diabetes largely remains suboptimal in most countries, which
are ill-prepared to face the control and prevention of diabetes,
as the costs of caring for the condition pose a challenge to most
local economies. Moreover, translation strategies to prevent and
control diabetes and obesity in Africa are still to be evaluated.
18,19
Altogether, the eight articles provide a timely and
comprehensive overview of the evidence currently available to
carry the fight against cardiovascular diseases into the second
decade of the 21st century and beyond. In the accompanying
editorial, Bongani Mayosi, the series editor, shows strong
support for the 10 key population-level interventions of proven
cost-effectiveness that are well-suited to the low-income settings
of African countries, as the appropriate recipes for preventing
cardiovascular diseases from compromising the long-expected
and gradually experienced economic development of the African
continent.
20
Concerted action will be needed to integrate the ‘10
best buys’ for the prevention and treatment of heart disease,
diabetes and stroke in the national plans for action on NCDs in
African countries.
ANDRE PASCAL KENGNE,
Department of Medicine, University of Cape Town and South
African Medical Research Council, Cape Town, South Africa
BONGANI M MAYOSI
Department of Medicine, Groote Schuur Hospital and
University of Cape Town, Cape Town, South Africa
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